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�o�io���� <br />UCC FINANCING STATEMENT ADDENDUM <br />FOlLOW INSTRUCTIONS (front and back) CAREFULLY <br />9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT <br />9a. ORGANIZATION'S NAME <br />OR <br />9b. INDIVIDUAL'S LAST NAME � FIRST NAME MID <br />JACOBSON GARY R <br />10. MISCELlANEOUS: <br />11. ADDITIONAL DEBT OR'S EXACT FUIL LEGAL NAME - insert <br />11a. ORGANIZATION'S NAME <br />� 11b. INDIVIDUAL'S LAST NAME <br />' THE ABOVE SPACE I S FOR FILING OFFICE USE ONLY <br />name (11 a or t t b) - do not abt�reviate or combfne names <br />NAME <br />11d. &EE INSTRUCTIONS ApD'L INFO RE I 71e. TYPE OF ORGANIZATION I 11L JURISD�CTI <br />ORGANIZATION � <br />DEBTOR <br />12. ADDITIONAL SECURED PARTY'S � ASSIGNOR S!P'S NAME - insert <br />12a. ORGANIZATION'S NAME <br />OR �Zb. INDIYtDUACSIAST NAME . FIRST NAME <br />OF ORGANIZATION I11g. ORGANIZATIONAL Ip #, if any <br />� � NONE <br />r Qpg name (12a or 12b) <br />MIDOLE NAME SUFFIX <br />13. This FINANCING STATEMENT covers � timber to be cut or � as-eMracted 16. Additlonal collateral desaiptiorc <br />collaleral, or is filed as a� fiMure filing. <br />14. Desaiptio� of real eatale: <br />ONE DWELLING WITH ATTACHED GARAGE & <br />_ 6' X 12' STORAGE BUILDING, TOGETHER WITH <br />.�if�,L FiYTIJ�S THERETCf I.O�t1T1 AT �4 <br />KUESTER LAKE, GRAND ISLAND, NEBRASKA, <br />UPON LEASED GROUND DESCRIBED AS <br />FOLLOWS: <br />LOT I8, HAVING A LAKE FRONT FOOTAGE 78' <br />SITUATED ON THE WEST PORTION OF <br />KUESTER LAKE, AND BEING ON A PART OF <br />THE El/2 SWl/4 IN SECTION 13, TOWNSHIP 11 <br />NORTH, RANGE 9 WEST OF THE 6TH P.M., <br />HALL COUNTY NEBRASKA. p <br />15. Name end address of a RECORD OWNER of above-described real estale <br />(if Debtor does nM have a record interest): . <br />� 17. Cbeck 4 I�r if applicable and check onfv one box. <br />� Debtor is a Tmst or Trustee acting with respect to property held in irust or DecedenPs Estate <br />18. Check onlv if applicable and check gr�y ona box. <br />❑ Debiw is a TRANSMITTING UTIUTY � <br />� Filed in connection with a Manufactured-HOme Transaction <br />Filed in connection with a Public-Finance Transadion <br />International Association of Commercial Administrators (IACA) <br />FILING OFFICE COPY — UCC FINANCING STATEMEnT ADDENDUM (FORM UCC1Ad) (REV. 05/21/09) <br />